As one of the largest pharmacy benefits managers in the United States, UnitedHealth Group provides a professional culture where you're empowered and encouraged to exceed the expectations of our members, with better schedules than retail and more reach than any hospital. Join us and start doing your life's best work.(sm)
The Manager, Prior Authorization leads and manages the Prior Auth Supervisors (6), Clinical Pharmacists and the Prior Authorization Pharmacy Technicians (staff 140+ indirects) to achieve overall performance objectives to the satisfaction of clients.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Communicates directly with Prior Authorization Clinical Pharmacists to ensure all commitments are met in a self-directed team environment
- Exercises judgment & initiative to resolve problems and recommend solutions to complex Prior Authorization related issues
- Holds periodic consultations with practitioners in the field, when indicated
- Supports the development and management of clinical program, quality improvement program, market intelligence, and utilization management initiatives
- Provides cross-coverage support for prior authorization processing
- Provide oversight of daily PA operations across Cypress, Mission Valley, Costa Mesa and Oklahoma City locations including real time PA inventory and queue management, to ensure all applicable turnaround times (TAT) are met or exceeded
- Work collaboratively with other PA site leadership from other facilities toward cohesive operations flow including regular daily telephonic meetings
- Ensures appropriate and comprehensive utilization management application of clinical criteria for approval / denial determinations, to ensure quality of care, appropriateness of use, and cost effective prescription therapies in compliance with quality standards
- Assists in developing and implementing strategies to improve operational efficiencies, trend review analysis, quality improvement projects, procedures, policies, and processes
- Communicates and collaborates with management on developing and executing short- and long-term Prior authorization department strategic goals
- Assists in the development, management, and completion of processes for compiling information for audit preparation and documentation to support regulatory requirements
- Assists with developing standard utilization review reports and reporting requirements related to ad hoc, contractual, and non-contractual requests of utilization review data
- Assists with ensuring adherence to related utilization review / prior authorization client performance guarantees to avoid penalties for failure to comply
- Responds to escalated prior authorization calls and / or issues
- Assists Client Services with questions related to prior authorizations
- Performs other duties and responsibilities as assigned
- Active, unrestricted pharmacist license in state of CA
- 3+ years of previous leadership / staff management experience
- PBM experience
- Ability to be in Costa Mesa, CA office regularly (2-3x week)
- Working knowledge of Medicare Part D regulations & CMS regulations
- Proficiency with Microsoft Word, Excel, PowerPoint, Outlook
- Direct experience with Prior Authorization
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: pharmacist, prior authorization, PBM, Medicare, Overland Park, Kansas, KS